The α3β1 integrin shows strong, stoichiometric, direct lateral association with the tetraspanin CD151. As shown here, an extracellular CD151 site (QRD^194–196) is required for strong (i.e., Triton X-100–resistant) α3β1 association and for maintenance of a key CD151 epitope (defined by monoclonal antibody TS151r) that is blocked upon α3 integrin association. Strong CD151 association with integrin α6β1 also required the QRD^194–196 site and masked the TS151r epitope. For both α3 and α6 integrins, strong QRD/TS151r-dependent CD151 association occurred early in biosynthesis and involved α subunit precursor forms. In contrast, weaker associations of CD151 with itself, integrins, or other tetraspanins (Triton X-100–sensitive but Brij 96–resistant) were independent of the QRD/TS151r site, occurred late in biosynthesis, and involved mature integrin subunits. Presence of the CD151–QRD^194–196→INF mutant disrupted α3 and α6 integrin–dependent formation of a network of cellular cables by Cos7 or NIH3T3 cells on basement membrane Matrigel and markedly altered cell spreading. These results provide definitive evidence that strong lateral CD151–integrin association is functionally important, identify CD151 as a key player during α3 and α6 integrin–dependent matrix remodeling and cell spreading, and support a model of CD151 as a transmembrane linker between extracellular integrin domains and intracellular cytoskeleton/signaling molecules.